Sulfur is a tasteless, yellow crystalline solid. In nature, it can be found as the pure element or in sulfide and sulfate minerals. Sulfur is a constituent of petroleum, sulfuric acid, and natural gas. Its commercial uses are primarily in fertilizers, but it is also widely used in gunpowder, matches, insecticides, and fungicides.

Elemental sulfur is present in all living tissues. After calcium and phosphorus, it is the third most abundant mineral element in the human body. It is essential for life and is found in two amino acids, cysteine and methionine. Sulfur is found in foods such as meat, garlic, onion, dates, and broccoli. Dietary sulfur supplementation may be indicated for vegan athletes, children, the elderly, or patients with HIV, as these populations are at an increased risk for sulfur deficiency.

Sulfur is commonly used in homeopathic medicine to treat acne, rosacea (facial inflammation), scabies, seborrheic dermatitis (skin inflammation), tinea versicolor (fungal skin infection), recurrent upper respiratory tract infection, and dandruff. Sulfur, used alone or in combination with other agents, has demonstrated efficacy in the treatment of many skin conditions.

Balneotherapy (mineral baths) is one of the oldest forms of therapy for patients with arthritis. There is evidence supporting the use of sulfur baths for the treatment of rheumatism and rheumatoid arthritis. While is not enough clinical evidence to recommend sulfur baths in replacement of standard modes of therapy for osteoarthritis, it may be safely added to standard regimens.

Sulfur preparations have been studied for use in allergic rhinitis, ankylosing spondylitis (a form of arthritis), arthritis (psoriatic), atherosclerosis (hardening of the arteries), the common cold, dandruff, deafness (rhinogenic), fibromyalgia (muscle and soft tissue pain), inflammation (rhinopharyngotubaric phlogoses), pain (rheumatic disease), rheumatoid arthritis, rosacea (facial inflammation), scabies, and skin disorders. High-quality human trials supporting the use of sulfur for conditions other than osteoarthritis are lacking at this time.

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

GRADE *

Some evidence suggests that shampoo containing sulfur may be useful for dandruff control. Additional studies are needed to confirm these results.

B

Some evidence suggests that sulfur bath therapy may have an effect on osteoarthritis when added to standard therapy. Additional studies are needed to confirm these results.

B

Limited evidence suggests that a homeopathic nasal spray containing Luffa operculata, Galphimia glauca, histamine, and sulfur may have an effect on allergic rhinitis. Further research is needed to examine the effects of sulfur alone.

C

Limited evidence suggests that a combination of climatic therapy, mud packs, and sulfur baths at the Dead Sea improved the condition of patients suffering from long-standing ankylosing spondylitis (a form of arthritis). Additional studies are needed to examine the effects of sulfur therapy alone.

C

Limited evidence suggests that addition of mud packs and sulfur baths to ultraviolet exposure from the sun and Dead Sea baths may have additive effects on reducing inflammatory back pain. Additional studies are needed to examine the effects of sulfur therapy alone.

C

Limited evidence suggests that sulfur water from the Wieslaw spring in Busko-Solec, Poland, improved fat and cholesterol levels and clotting profiles in patients with atherosclerosis (hardening of the arteries). Further studies need to be performed to determine if sulfur was indeed the active agent in this spring water.

C

Limited evidence suggests that Engystol® (a homeopathic combination formula of swallow-wort and sulfur) may be a useful component of an integrated symptomatic therapy for the common cold. Studies on sulfur therapy alone need to be performed.

C

Limited evidence suggests that sulfur inhalation therapy using endotympanic ventilation or the Politzer method may improve middle ear function in children. Further studies in this area are needed.

C

There is preliminary evidence suggesting that treatment of fibromyalgia (muscle and soft tissue pain) at the Dead Sea is effective and safe. Further research is needed in this area.

C

Limited evidence suggests that sulfurous, salty, bromic, iodic thermal waters may improve IgA and albumin concentrations in nasal secretions. It is unclear if sulfur is the active agent in this treatment.

C

Limited evidence suggests that sulfur baths may lower pain sensitivity in patients with rheumatic diseases of the soft tissues. Further research in this area is warranted.

C

Limited evidence suggests that sulfur baths may have beneficial effects in rheumatoid arthritis (RA) patients similar to that of Dead Sea bathing and mud pack therapy. Better-designed studies are needed in this area.

C

Preliminary evidence suggests that a 10% sodium sulfacetamide/5% sulfur emollient (SSSE) may have potential to improve rosacea (facial inflammation). Further research in this area is warranted.

C

Preliminary evidence suggests that a mixture of 2-8% precipitated sulfur petrolatum may effectively treat scabies in children under five years of age, as well as in pregnant and lactating women and the elderly, in whom other drugs are not recommended. Better-designed studies are warranted.

C

Studies of lesser quality suggest that sulfur may be useful in treating skin disorders. Better-designed studies are warranted.

C

* Key to grades

A: Strong scientific evidence for this useB: Good scientific evidence for this useC: Unclear scientific evidence for this useD: Fair scientific evidence for this use (it may not work)F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

For acne, lotions, ointments, creams, or soaps containing 1-10% sulfur have been applied to affected areas. Manufacturers usually recommend applying creams or ointments to the entire affected area, 1-3 times daily.

For atherosclerosis (hardening of the arteries), 50 milliliters of undiluted sulfur spring water has been taken by mouth three times daily for four weeks.

For chronic lichen simplex (long-term itching and thickening of the skin), 200 milliliters of a homeopathic preparation has been taken by mouth once daily for one year.

For dandruff, a shampoo containing 2% sulfur has been used. Manufacturers recommend shampooing as often as once daily until flakes are under control.

For fibromyalgia (muscle and soft tissue pain), sulfur baths have been used for 10 days.

For osteoarthritis, bathing in a sulfur pool for 2-3 weeks or twice weekly for six consecutive weeks has been used.

For rheumatoid arthritis, daily sulfur baths for 12-14 days have been used.

For rosacea (facial inflammation), the manufacturer of Rosula® recommends using an ointment containing 10% sulfur applied every night for three weeks or a lotion containing 10% sulfacetamide with 5% sulfur applied 1-3 times daily.

For scabies, an ointment containing 2-8% precipitated sulfur in petrolatum has been applied once daily for six days, followed by a one-week rest period, application for two days, thoroughly washing off with neutral soap, and application of lubricant cream.

For seborrheic dermatitis, a manufacturer recommends using a shampoo containing 2% sulfur and salicylic acid daily or every other day until noticeable improvement, then once or twice per week. Alternatively, a lotion containing 10% sulfacetamide with 5% sulfur may be applied 1-3 times daily.

Children (under 18 years old)

For deafness (rhinogenic), sulfur inhalation therapy (aerosol + Politzer) have been used for 12 consecutive days.

For scabies, an ointment containing 2-8% precipitated sulfur in petrolatum has been applied once daily for six days, followed by a one-week rest period, application for two days, thoroughly washing off with neutral soap, and application of lubricant cream. Concentrations have been 2% for children up to six years old, and 2-5% for adolescents and pregnant women. Children under two years old have worn the ointment for three hours, while all others have worn it overnight.

Safety
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid in individuals with a known allergy or sensitivity to sulfur. Rare hypersensitivity reactions from sodium sulfacetamide in topical acne treatments have been reported.

Sulfur may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or those taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

Use cautiously in infants. There are reports of deaths in infants after application of sulfur to large areas of the body for the treatment of scabies.

Use heated sulfur baths cautiously, as serious adverse reactions to heat may be possible.

Use cautiously in patients with kidney disease, as sulfur ingestion may cause kidney damage.

Use concentrated sulfur products cautiously, as ingestion of elemental sulfur is known to be poisonous.

Use cautiously in patients with sensitive skin.

Use cautiously in patients with gastrointestinal sensitivities. Swallowing large amounts may cause nausea, vomiting, and diarrhea.

Use caution with sulfur products taken by mouth, as ingestion of sulfur may cause sulfhemoglobinemia, a rare blood condition.

Use cautiously in patients with an allergy or sensitivity to sulfonamides.

Avoid using or storing sulfur products near a heat source or other chemicals.

Avoid the use of topical sulfur on irritated skin.

Avoid the use of concentrated sulfur on the skin.

Avoid getting sulfur products near the eyes, as the U.S. Environmental Protection Agency (EPA) reports that it is an eye irritant. In case of contact with eyes, rinse immediately with plenty of water and seek medical advice.

Avoid inhaling sulfur products, as overexposure to sulfur has caused respiratory disturbances, chronic bronchitis, chronic sinus effects, chest discomfort, asthma, difficulty breathing, and irritation of the respiratory tract. Breathing of dust may aggravate asthma and other pulmonary diseases. Local adverse effects were reported to be associated with a sulfur-containing nasal spray.

Avoid use of sulfur preparations in pregnant or breastfeeding patients, due to a lack of safety information.

Avoid in individuals with a known allergy or sensitivity to sulfur. Rare hypersensitivity reactions from sodium sulfacetamide in topical acne treatments have been reported.

Pregnancy and Breastfeeding

Sulfur is likely safe when consumed by nonallergic women in amounts generally found in foods. It is not recommended for medicinal use in pregnant or breastfeeding patients, due to a lack of safety information.

Sulfur may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin®) or heparin, antiplatelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

Sulfur may also interact with anti-inflammatory drugs, cholesterol-lowering drugs, isotretinoin, laxatives, and retinoids.

Interactions with Herbs and Dietary Supplements

Sulfur may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

Sulfur may also interact with anti-inflammatory herbs and supplements, cholesterol-lowering herbs and supplements, and laxatives.

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.